Ethnicity & Health

Is HPV vaccine awareness associated with HPV knowledge level? Findings from HINTS data across racial/ethnic groups in the US

Human papillomavirus (HPV) is recognized as a leading cause of multiple types of cancer. The current study examined HPV knowledge level and its associated factors, especially its relationship with HPV vaccine awareness, across race/ethnicity, including non-Hispanic White, non-Hispanic African American, and Hispanic. Cross-sectional data were merged from Cycles 1 (2017) and Cycle 2 (2018) of the National Cancer Institute (NCI) Health Information National Trends Survey 5 (HINTS5, total Overall HPV knowledge level among participants was low (Mean = 1.68; SD = 1.44; range 0-4). Among three racial/ethnic groups, non-Hispanic African American had the lowest level of HPV knowledge (Mean = 1.51). Less than 30% answered correctly to each of the three items assessing knowledge of HPV-associated (HPVa) cancers other than cervical (e.g. if HPV can cause penile, anal, and/or oral cancer). The HPV vaccine awareness was significantly associated with HPV knowledge across all three racial/ethnic groups. The lowest level of HPV knowledge among non-Hispanic African American suggests that HPV education is urgently needed for this population. Specific interventions should emphasize information regarding HPVa cancers other than cervical cancer. Additionally, promoting awareness of the HPV vaccine will help to improve HPV knowledge among general population. Lastly, various factors associated with HPV knowledge across different racial/ethnic groups need to be addressed when implementing HPV education programs.

Disparities in cervical cancer screening among Arabic-speaking women refugees

Cervical cancer remains one of the most common cancers among females and one of the top causes of cancer-related deaths worldwide. Minority women are disproportionately more vulnerable. This study addressed disparities in cervical cancer screening among Arabic-speaking women refugees. We conducted a cross-sectional study using qualitative and quantitative research methods at a Federally Qualified Health Center (FQHC) in Cleveland, Ohio, in the United States of America (USA). A structured phone-based survey was developed and administered in Arabic. The study was conducted from 2018 to 2019 and involved 20 participants. Inequity in cervical cancer screening exists among Arab women refugees (41% being up to date with their screening) compared to their English- and Spanish-speaking counterparts (51%). These women perceived that the top three barriers to cervical cancer screening were fear of cancer, language, and lack of knowledge. The top three perceived facilitators were the doctor's recommendation, reminders from the provider's office, and awareness of cervical cancer screening. Our work brings unique insights into improving preventive care services for Arabic-speaking women. These findings add unique insight focused on improving preventive care in this group and can inform interventions to increase cancer screening amongst Arabic-speaking women.

Qualitative assessment of attitudes toward cervical cancer (CC) screening and HPV self-sampling among African American (AA) and Sub Saharan African Immigrant (SAI) women

Despite the availability of preventive methods for cervical cancer (CC), uptake has been low among African American and Sub-Saharan Immigrant (AA/SAI) women. The purpose of this study was to understand AA/SAI women's values and beliefs of CC screening and explore willingness, acceptability, and concerns related to the HPV self-sampling method for CC. Thirty AA/SAI women participated in one of six focus groups, each lasted 60-90 min, and were held over Zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy by research staff prior to data analysis. Transcripts were content analyzed by two qualitatively trained research staff. NVivo software was used for data management and analysis. The average age of participants was 33.67 ± 9.03, more than half were not married (53.3%), and less than half reported having health insurance coverage (46.7%). Participants included 16 AA and 14 SAI. Three main themes emerged from data analysis. (1) Beliefs and values related to CC Screening, (2) perceived barriers to attending CC screening, (3) recommendations to motivate regular CC screening. In addition, three factors emerged in the discussion on the HPV self-sampling method: confidence in ability to self-sample for CC, willingness to use HPV self-sampling kit, and result delivery. This study identified a variety of reasons for the disproportionately low utilization of CC prevention services among AA/SAI women. Multidimensional approaches including educational and community engagement programs for this population could improve CC screening uptake and adoption of HPV self-sampling among AA/SAI women.

Conversations about sexual activity within Haitian families: implications for HPV vaccine uptake

Awareness, knowledge, social norms, and vaccination intentions among Khmer mother–daughter pairs

Cervical cancer is caused by human papillomavirus (HPV) infection, which can be prevented by vaccination. Mothers play an important role in promoting vaccination and health education. However, Cambodian American mothers reported to have challenges to play a role as primary health educators due to lack of health knowledge and language and cultural gaps. Therefore, this study aims to understand the Cambodian American daughters' and mothers' awareness, knowledge and social norms of HPV vaccination and their health communication and vaccination decision-making. We conducted a pilot randomized clinical trial to promote HPV vaccination. In this study, we have only reported findings from baseline data examining individual, interpersonal and social determinants of HPV vaccination behavior among 19 dyads of Cambodian American mothers and daughters. Both mothers and daughters demonstrated low levels of awareness and knowledge. A significant relationship was found between the daughters' HPV vaccine decisions and their perception of their mothers' intention on HPV vaccination for them. Culturally and linguistically appropriate communication strategies such as storytelling or visual presentation approaches may be more effective than the current practice of using information-based written materials to promote HPV vaccination and health education among Cambodian Americans.

Diverse caregivers’ HPV vaccine-related awareness and knowledge

Asian American sub-ethnic disparities and trends in epithelial ovarian cancer diagnosis, treatment and survival

Studies on ovarian cancer (OC) diagnosis, treatment and survival across disaggregated Asian sub-ethnic groups are sparse. Few studies have also conducted trend analyses of these outcomes within and across Asian groups. Using logistic, Cox, and Joinpoint regression analyses of the 2000-2018 Surveillance, Epidemiology, and End Results (SEER) data, we examined disparities and trends in OC advanced stage diagnosis, receipt of treatments and the 5-year cause-specific survival across seven Asian sub-ethnic groups. There were 6491 OC patients across seven Asian sub-ethnic groups (mean [SD] age, 57.29 [13.90] years). There were 1583(24.39%) Filipino, 1183(18.23%) Chinese, and 761(11.72%) Asian Indian or Pakistani (AIP) patients. The majority (52.49%) were diagnosed with OC with at an advanced stage. AIP were more likely to have advanced stage diagnosis than other subgroups (ORs, 95%CIs: 0.77, 0.62-0.96 [Filipino]; 0.76, 0.60-0.95 [Chinese]; 0.71, 0.54-0.94 [Japanese]; 0.74, 0.56-0.98 [Vietnamese] and 0.66, 0.53-0.83 [Other Asians]). The Filipinos were least likely to receive surgery but most likely to undergo chemotherapy. Japanese patients had the worst 5-year OC cause-specific survival (50.29%, 95%CI: 46.20%-54.74%). Based on the aggregated analyses, there was a significantly decreased trend in advanced-stage diagnosis and an increased trend in receipt of chemotherapy. Trends in OC outcomes for several subethnicities differed from those observed in aggregated analyses. In this cohort study of 6491 patients, OC diagnosis, treatment, survival, and trends differed across Asian American ethnic subgroups. Such differences must be considered in future research and interventions to ensure all Asian American subethnicities equally benefit from the advancements in OC care and control.

Experiences of a group of indigenous women from the Colombian Amazon with cervical cancer prevention screening. Qualitative study in the context of participatory research to reduce inequalities

Despite cervical cancer (CC) being a preventable disease, its incidence remains high in marginalized communities due to inequalities that restrict access to health services. This article investigates the experiences, perceptions, and attitudes regarding the screening of indigenous women in a region of the Colombian Amazon during a cervical cancer prevention initiative facilitated by community participation. Qualitative study based on interviews conducted with women and indigenous leaders from Paujil reserve. They participated in research focused on cervical cancer prevention, which employed a methodology of collaboration between academia and communities aimed at enhancing women's health and reducing inequalities in access to healthcare services. The analysis utilized a deductive and inductive approach. Five main themes were addressed: 'Barriers within health services'; 'Individual and cultural constraints'; 'Motivations and facilitators'; 'Positive experiences within the research framework'; and 'Suggestions for encouraging women's participation.' Challenges related to appointment scheduling and result delivery were frequently cited as obstacles to access. Misinformation, feelings of shame, fear, and distrust towards health services played significant roles in the reluctance to undergo screening. Factors such as support from family and community networks, respectful treatment, ease of scheduling appointments, the presence of female healthcare professionals, and involvement of leaders fluent in indigenous languages were identified as positive facilitators of screening acceptance. Understanding the factors that influence access to screening is crucial for reducing inequalities in service delivery for indigenous women. The involvement of trained leaders who can identify these factors and motivate women can have a positive impact on the acceptance and guidance of cervical cancer prevention programs.

Stakeholders’ perspectives on system-level barriers to and facilitators of HPV vaccination among Hispanic migrant farmworkers

Latinx populations suffer from a disproportionate burden of HPV-related cancers, yet vaccination completion rates nationally among this population remain low, with 46% of females and 35% of males completing the vaccine series. Given the heterogeneity of Latinx populations, sub-populations such as Latinx individuals who live in migrant farmworker communities experience additional system-level barriers to healthcare utilization. Thus, we examined stakeholder perceptions of barriers and facilitators to Human Papillomavirus (HPV) vaccination among Latinx migrant farmworkers. Such information is critical to informing intervention development targeting vaccination uptake and completion, ultimately decreasing HPV-related cancer disparities. Guided by the PRECEDE-PROCEED model and the Social Ecological Model (SEM), interviews were conducted with diverse stakeholders ( Micro-level facilitators identified included positive attitudes and vaccine acceptance among parents. Meso-level facilitators included availability of free or low-cost health care clinics, and macro-level facilitators included federal programs (e.g. Medicaid, Vaccine for Children). Micro-level barriers included lack of education and low health literacy. Meso-level barriers included poor patient-provider communication, lack of access (e.g. clinics not stocking/administering the vaccine; limited clinic hours; lack of reminder systems; insufficient organizational structure), public perceptions/attitudes towards HPV vaccination, and lack of healthcare service continuity due to migratory patterns. Macro-level barriers included public perceptions and attitudes towards HPV vaccination, transportation, vaccine availability and coverage for non-citizens, and lack of school entry policy. Findings suggest that multi-level interventions should be developed to leverage existing facilitators while addressing system-level barriers, ultimately creating a supportive environment for HPV vaccine initiation and completion among this marginalized population comprised of individuals living in migrant farmworker communities.

Decision-making, barriers, and facilitators regarding cervical cancer screening participation among Turkish and Moroccan women in the Netherlands: a focus group study

Cervical cancer, human papillomavirus (HPV), and HPV vaccination: exploring gendered perspectives, knowledge, attitudes, and cultural taboos among Mexican American adults

Cancer screening educational interventions in rural and farmworker communities: a systematic literature review

Men and women living in rural communities of the United States (US) are less likely than those in urban or suburban communities to be up to date with cancer screenings. Delayed screening contributes to later stage at diagnosis and higher cancer mortality for individuals living in rural areas. These effects may be compounded in some rural subpopulations (e.g. migrant and seasonal farmworkers). This systematic review examines educational interventions aimed at increasing colorectal, breast, prostate, oral, and/or cervical cancer screening in the rural US, with special consideration for the farmworker subpopulation. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, our systematic literature review employed the following databases: Ovid MEDLINE, CINAHL Complete, Embase, and Web of Science. Search terms included, but were not limited to 'rural,' 'cancer screening,' 'farmworker,' and 'cancer prevention.' Eligible studies featured an educational intervention implemented in agricultural or rural US settings with a cancer screening behavioral outcome, male and/or female participants, and were published in English between 2002 and 2020. Article screening and data extraction were conducted by two independent reviewers. Twenty-six articles were eligible. Of the six studies focused on the farmworker population ( Results demonstrate the value of LHAs and targeted education to increase screening for multiple cancer types in rural communities. Prospective research should incorporate and facilitate access to screening and provider-level and/or organizational-level interventions to increase overall impact. HPV: human papillomavirus; LHA: lay health advisors; MeSH: Medical Subject Headings; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT: randomized controlled trial; US: United States.

Development and evaluation of a multimedia intervention to promote cervical cancer prevention among South Asian women in Hong Kong

Reconstructing trust in preventive care: Black women’s perspectives on equity-centered, cervical cancer interventions

Black women in the United States face disproportionately high rates of cervical cancer incidence and mortality, driven in part by structural racism, medical mistrust, and barriers to culturally responsive care. Existing interventions often overlook the lived experiences of Black women and fail to address the systemic roots of healthcare inequities. To explore how Black women conceptualize healthcare mistrust and identify multilevel changes needed to improve cervical cancer screening and equity-centered preventive care. Seventeen in-depth, semi-structured interviews were conducted with self-identified Black women aged 21-65 years between February and April 2023. Guided by an integrated theoretical framework including Ecological Systems Theory, Ecosocial Theory of Embodiment, Intersectionality, and Black Feminist Thought. Interviews were thematically analyzed to surface key barriers and recommendations. Participants were recruited through purposive sampling, and thematic saturation was achieved. Four major themes emerged: (1) increasing access to affordable, community-centered healthcare; (2) expanding reproductive health knowledge and addressing informational gaps; (3) enhancing provider training in diversity, equity, and culturally responsive care; and (4) implementing systemic reforms to rebuild trust and deliver holistic, justice-driven healthcare. Participants underscored the importance of long-term community engagement, generational knowledge transfer, and trauma-informed care. Trust was framed as a central determinant, shaped by intersecting histories of discrimination and institutional exclusion. This study highlights the urgent need for systemic transformation in preventive care delivery. Improving cervical cancer outcomes among Black women requires multilevel strategies that prioritize trust, equity, and the leadership of communities most affected. These insights inform policy, provider training, and structural reforms aimed at advancing justice in healthcare.

Contextualizing HPV vaccination intention among Haitian immigrant and migrant women through exploring cultural worldviews and affective risk perception: a qualitative study

Haitian women experience high rates of cervical cancer and are more likely to be diagnosed at advanced stages. Although the HPV vaccine is effective in preventing cervical cancer, limited data exists regarding factors influencing HPV vaccine uptake among Haitian women. Our study explored HPV vaccination knowledge, awareness, and intentions through the domains of cultural worldviews and risk perception among Haitian immigrant and migrant women who recently arrived to the United States. These qualitative data are from a larger exploratory sequential mixed-methods study evaluating HPV vaccination intention among Haitian immigrant and migrant women. Semi-structured in-depth interviews were conducted with N = 25 participants. Interviews contained questions exploring health beliefs and knowledge, women's cervical cancer experiences, cultural worldviews, affective evaluations of cervical cancer risk perception, and HPV vaccination intention. Qualitative descriptive methodology using thematic analysis was employed for data analysis on Atlas.ti software. HPV vaccination knowledge and awareness were exceptionally low in our sample. Women endorsed maintaining cultural practices and beliefs upon migrating to the U.S. which shaped their decision to engage in health promotion behaviors. In response to affective risk perception, women believed that the unpredictability of cervical cancer increased their susceptibility to the disease. Participants endorsed cervical cancer as a fatal illness, with this perception being partly driven by superstitious beliefs toward cervical cancer, along with women's prior experience with the health system in Haiti. These factors demonstrated potential relevance toward women's decision making to engage in HPV vaccination behaviors. Culture, affective risk perception, and past experiences may be relevant toward Haitian women's decision making to engage in HPV vaccination practices. Our results underscore the importance of using alternative methods in understanding HPV vaccination intention and scaling up HPV vaccination efforts for Haitian women both in the U.S. and in Haiti.

The intersection of race/ethnicity and socioeconomic status: inequalities in breast and cervical cancer mortality in 20,665,005 adult women from the 100 Million Brazilian Cohort

There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with race/ethnicity. The 100 Million Brazilian Cohort data were linked to the Brazilian Mortality Database, 2004-2015 (n = 20,665,005 adult women). We analysed the association between self-reported race/ethnicity (White/'Parda'(Brown)/Black/Asian/Indigenous) and cancer mortality using Poisson regression, adjusting for age, calendar year, education, household conditions and area of residence. Additive and multiplicative interactions were assessed. Cervical cancer mortality rates were higher among Indigenous (adjusted Mortality rate ratio = 1.80, 95%CI 1.39-2.33), Asian (1.63, 1.20-2.22), 'Parda'(Brown) (1.27, 1.21-1.33) and Black (1.18, 1.09-1.28) women vs White women. Breast cancer mortality rates were higher among Black (1.10, 1.04-1.17) vs White women. Racial inequalities in cervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicative interaction <0.001, and 0.02, respectively). Compared to White women living in completely adequate (3-4) household conditions, the risk of cervical cancer mortality in Black women with 3-4, 1-2, and none adequate conditions was 1.10 (1.01-1.21), 1.48 (1.28-1.71), and 2.03 (1.56-2.63), respectively (Relative excess risk due to interaction-RERI = 0.78, 0.18-1.38). Among 'Parda'(Brown) women the risk was 1.18 (1.11-1.25), 1.68 (1.56-1.81), and 1.84 (1.63-2.08), respectively (RERI = 0.52, 0.16-0.87). Compared to high-educated White women, the risk in high-, middle- and low-educated Black women was 1.14 (0.83-1.55), 1.93 (1.57-2.38) and 2.75 (2.33-3.25), respectively (RERI = 0.36, -0.05-0.77). Among 'Parda'(Brown) women the risk was 1.09 (0.91-1.31), 1.99 (1.70-2.33) and 3.03 (2.61-3.52), respectively (RERI = 0.68, 0.48-0.88). No interactions were found for breast cancer. Low SES magnified racial inequalities in cervical cancer mortality. The intersection between race/ethnicity, SES and gender needs to be addressed to reduce racial health inequalities.

Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups

Cervical cancer sociodemographic and diagnostic disparities in Florida: a population-based study (1981–2013) by stage at presentation